Abstract
Energy intake requirements in pregnancy match the demands of resting metabolism, physical activity, and tissue growth. Energy balance in pregnancy is, therefore, defined as energy intake equal to energy expenditure plus energy storage. A detailed understanding of these components and their changes throughout gestation can inform energy intake recommendations for minimizing the risk of poor pregnancy outcomes. Energy expenditure is the sum of resting and physical activity-related expenditure. Resting metabolic rate increases during pregnancy as a result of increased body mass, pregnancy-associated physiological changes, i.e., cardiac output, and the growing fetus. Physical activity is extremely variable between women and may change over the course of pregnancy. The requirement for energy storage depends on maternal pregravid body size. For optimal pregnancy outcomes, women with low body weight require more fat mass accumulation than women with obesity, who do not require to accumulate fat mass at all. Given the high energy density of fat mass, these differences affect energy intake requirements for a healthy pregnancy greatly. In contrast, the energy stored in fetal and placental tissues is comparable between all women and have small impact on energy requirements. Different prediction equations have been developed to quantify energy intake requirements and we provide a brief review of the strengths and weaknesses and discuss their application for healthy management of weight gain in pregnant women.
Highlights
Pregnancy is a determining period of future health for women and children
Given that 160 kcal/d is mobilized from fat tissue, while the accumulation of fat-free mass only requires 20–60 kcal/d, the factor of energy storage in the energy balance equation is negative and energy intake in pregnant women with obesity should be lower than energy expenditure
Energy intake requirements during the first trimester are minimally different from requirements before pregnancy (Table 2)
Summary
Pregnancy is a determining period of future health for women and children. For the mother, poor pregnancy outcomes including excess gestational weight gain, gestational diabetes, hypertension and preeclampsia, or having a cesarean section increase the risk for future obesity, type 2 diabetes and cardiovascular diseases [1,2]. Only one study estimated energy costs for recommended weight gain [8], but classification of both maternal pregravid body mass index (BMI) and recommendations for weight gain in pregnancy have since been revised. The prevalence of obesity is even larger among women of ethnic minorities (African American 57%, Hispanics 43%), yet the vast majority of women studied were Caucasian These are important considerations for the assessment of energy requirements because both obesity and race have well-established effects on energy expenditure. To assist women and healthcare providers in achieving healthy rates of gestational weight gain, prediction models have been developed to estimate energy intake requirements.
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